Psychology of Mental Health Exam Section A- Diagnostic systems Question

There is a fair amount of evidence in support of the use of the DSM-5 and ICD-10 in providing clinically useful treatment decisions. These diagnostic manuals provide the framework for health diagnosis and research. Although not without their faults, these paradigms enable medical professionals to draw reliable conclusions when diagnosing patients. (FOR)

However, there is more evidence against the use of these diagnostic manuals. Type 1 errors in the DSM-5 for instance, lead to people thinking that they're sick when they're not, this is dangerous as they are prescribed drugs that have side effects. (AGAINST)

Ultimately, there must be some sort of diagnostic system in place because without it, those experiencing mental health issues will struggle to get the appropriate treatment. Allen Frances (2012), summarises ‘The DSM and ICD may be flawed but it is far better than anything that is currently available’.

There is varying evidence and divided attitudes about diagnostic manuals. The main two diagnostic systems used today are, the DSM-5 and the ICD-10 (soon to be 11). 

The DSM was first published in 1952 and was designed to help psychiatrists communicate using a common system of diagnosis. This manual was problematic as things that are now accepted were listed as mental illnesses e.g. homosexuality was listed as ‘sociopath personality disorder’. The DSM-5 is mainly used in the US and is now in its fifth edition. It has developed to reflect social change and more tolerant attitudes.

The ICD is the most popular and commonly used diagnostic manual worldwide. ICD-10 (soon to be 11) is also supported by the World Health Organisation (WHO) and bases diagnoses on symptoms. The ICD-10 aims to improve all healthcare across the world and diseases and disorders are categorised into 10 groups.

Although many people argue against the use of these systems, the question remains whether there is enough evidence to suggest and support their abolishment.

Brown et al (2001) tested the reliability of the DSM- IV by studying anxiety and mood disorders through interviews. The findings of this study suggest that the DSM is improving.

Fritscher (2013) suggests that the DSM-5 offers more in depth and categories for certain disorders such as anxiety. Also argues that they provide concrete assessment of issues and assists in developing specific goals in therapy.

Moulton (2014) argues that diagnostic manuals help to guide research in mental health field, checklists ensure that different groups of researchers are studying the same disorder.  Also creates standard terminology alleviating ambiguity in patients’ records for treatments.

Similarly, Kurbasic et al (2008) argues that ICD-10 makes medical coding a universal language, so medical info no longer gets lost in translation. These improved codes make it easier for medical professionals to be specific in assessment and diagnosis. 

Rosenhan (1973) tested the reliability of diagnosis for mental disorders and found that there was a tendency toward type 1 errors in normal diagnosis and type 2 errors when the stakes were high e.g. when diagnoses are being assessed. This highlights an issue with how these manuals are being used by medical professionals rather than with the systems themselves.

Frances (2012) discusses the over medicalisation of mental health. Grief is sometimes categorised as major depressive disorder (MDD), Binge eating disorder (BED) to people who just overeat and forgetfulness as mild neurocognitive disorder. This has created many type 1 errors in the DSM-5

Cromby et al (2013) argues that there are different cross-cultural perspectives of mental health which are not considered in systems like the DSM-5. For instance, in Japan hearing voices is seen as fox possession and treated with a Sharman, in Peru it is treated with healing rituals with family members and in the UK and US it is treated with medication and possibly being sectioned.

Hoffman et al (2015) suggest that diagnosis can differ depending on which diagnostic manual is being used. E.g. ICD-10 and DSM-5 agree on severe alcoholism diagnosis but differ on mild to moderate.

ICD-10 and DSM-5 are credited with bringing conditions in the public eye and making some better known in the UK. E.g. ADHD and borderline personality disorder.

Assists communication among health professionals and aid accuracy in treatment choice.

Positively effects patients as it normalises mental health- feel less alone, offers comfort and reassurance, allows access to services and benefits and creates a sense of community among those with similar diagnosis.  

Constantly updating and reflecting social change. DSM-5 has fewer diagnostic categories than previous versions They now look at other factors including functioning and distress.

These systems over medicalise patterns of behaviour and mood that are understandable or mild.  (Frances)

The labelling associated with psychiatric diagnosis can be damaging and limiting.  This negatively effects patients as they may experience stigma, discrimination and social exclusion, loss of personal meaning and loss of identity.

The BPS argues that diagnosis should fit the client but the DSM-5 tries to make the patient fit the diagnosis.

Reliability of these systems is questionable as not every diagnosis is the same from each medical professional with similar clients. (Hoffman et al then Rosenhan)